Functional Outcome Scales in Traumatic Brain Injury: A Comparison of the Glasgow Outcome Scale (Extended) and the Functional Status Examination
Clinical trials aimed at developing therapies for traumatic brain injury (TBI) require outcome measures that are reliable, validated, and easily administered. The most widely used of these measures, the Glasgow Outcome Scale (GOS) and the GOS-Extended (GOS-E), have been criticized as suffering from ceiling effects. In an attempt to develop a more useful and dynamic outcome measure, the Functional Status Examination (FSE) was developed, which grades outcome across 10 functional domains. The FSE has been demonstrated to be reliable and sensitive in monitoring recovery after TBI. This manuscript compares FSE with GOS-E in a cohort of patients with a wide range of injury severities. 177 individuals who survived at least 6 months after TBI were studied. The FSE and GOS-E were administered 6-12 months after injury. FSE and GOS-E scores correlated well with each other. FSE scores were distributed throughout the range, indicating that ceiling and floor effects were not present. Physiologic measures of injury severity (Glasgow Coma Score [GCS]) did not correlate with anatomic measures (Abbreviated Injury Scale [AIS] and Injury Severity Score [ISS]). GCS correlated weakly with both outcome measures, but AIS/ISS did not. We conclude that FSE and GOS-E are reliable outcome measures for TBI survivors, and FSE may offer some advantages over GOS-E due its ability to provide a more detailed description of deficits. The majority of the variance in outcome is not accounted for by currently available measures of injury severity.
[Show abstract] [Hide abstract] ABSTRACT: Gist reasoning (abstracting meaning from complex information) was compared between adults with moderate-to-severe traumatic brain injury (TBI, n = 30) at least one year post injury and healthy adults (n = 40). The study also examined the contribution of executive functions (working memory, inhibition, and switching) and memory (immediate recall and memory for facts) to gist reasoning. The correspondence between gist reasoning and daily function was also examined in the TBI group. Results indicated that the TBI group performed significantly lower than the control group on gist reasoning, even after adjusting for executive functions and memory. Executive function composite was positively associated with gist reasoning (p < .001). Additionally, performance on gist reasoning significantly predicted daily function in the TBI group beyond the predictive ability of executive function alone (p = .011). Synthesizing and abstracting meaning(s) from information (i.e., gist reasoning) could provide an informative index into higher order cognition and daily functionality.0Comments 2Citations
- "Daily-life function in the TBI group was examined on three self-reported functional measures, including Glasgow Outcome Scale– Extended (GOS–E, Wilson, Pettigrew, & Teasdale, 1998), Functional Status Examination (FSE, Dikmen, Machamer, Miller, Doctor, & Temkin, 2001), and Community Integration Questionnaire (CIQ, Willer, Ottenbacher, & Coad, 1994; seeTable 2 for description of measures , andTable 3 for daily function status). Each of these functional measures has been validated and used extensively in characterizing daily-life functioning in adults with TBI (Hudak et al., 2005; Shukla, Devi, & Agrawal, 2011). "
[Show abstract] [Hide abstract] ABSTRACT: Background: Ruptured intracranial aneurysm (ICA) with bleb formation (RICABF) is a special type of ruptured ICA. However, the exact role and effectiveness of endovascular coil embolization (ECE) in RICABF is unknown. We aimed to investigate the effectiveness and safety of ECE of aneurysm neck for RICABF treatment. Material and methods: We retrospectively assessed consecutive patients who were hospitalized in our endovascular intervention center between October 2004 and May 2012. Overall, 86 patients underwent ECE of aneurysm neck for 86 RICABF. Treatments outcomes included secondary rupture/bleeding rate, aneurysm neck embolization rate, residual/recurrent aneurysm, intraoperative incidents, and post-embolization complications, as well as improvements in the Glasgow outcome scale (extended) (GOS-E). Results: Complete occlusion was achieved in 72 aneurysms (72/86, 83.7%), while 12 aneurysms (12/86, 14.0%) had a residual neck, and 2 aneurysms (2/86, 2.3%) had a residual aneurysm. The postoperative GOS-E was 3 in 3 patients (3.5%), 4 in 10 patients (11.6%), and 5 in 73 patients (84.9%). Follow-up angiography was performed in all patients (mean 9.0 months, interquartile range of 9.0). Recurrence was found in 3 patients (3/86, 3.5%). No aneurysm rupture or bleeding was reported. Conclusions: Our mid-term follow-up study showed that ECE of aneurysm neck was an effective and safe treatment modality for RICABF. The long-term effectiveness and safety of this interventional radiology technique need to be investigated in prospective and comparative studies.0Comments 0Citations
- "Following the intervention, the patients received a loading dose of 150 mg of clopidogrel and 200 mg aspirin on day 1, followed by a dose of 75 mg clopidogrel or 100 mg aspirin per day. All patients were followed-up using the Glasgow outcome scale (extended) (GOS-E)  and by cerebral angiography within 12 months after the operation. "
- "Our study has some important limitations: first, it is a retrospective analysis and is therefore subject to the limitations of such analyses. Due to its retrospective design, a weakness of our study is a deficiency in accurately collecting some history and clinical information like formal neurologic or functional severity scores29303132 and the number of the patients who receiving mild-induced hypothermia, which has been demonstrated to have a strong beneficial impact on long-term survival and neurological status in the setting of outof-hospital cardiac arrest . Secondly, the nonrandomized nature of the comparison may have resulted into bias: for this reason, propensity score matching further enhanced the comparability of the patients. "